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Epilepsy Surgery May Be Best Bet When Medications Fail

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WebMD Health News

June 19, 2000 -- At least once a week, Jane Price dresses up as a clown and visits hospitals and nursing homes in Gardendale, Ala., where she lives. "When someone's in the hospital, they feel bored; they don't feel at home," she says. "A clown can bring patients a touch of joy. We call it 'therapeutic humor.'"

Price, a 54-year-old housewife, knows what it's like to live with a long-term illness. She has epilepsy, and no medication was able to treat it successfully. She used to have 10 to 20 seizures per month, but five years ago, her doctor encouraged her to look into surgery. "Since the surgery, I haven't had any seizures at all," she says.

Price is one of the lucky ones. About 80% of epilepsy patients can be controlled with medicine or surgery, but 20% can't be controlled even with treatment, according to the National Institute of Neurological Disorders and Stroke in Bethesda, Md. And the results of surgery for epilepsy are unpredictable. Still, for patients who aren't helped by medications, it may be the treatment of choice.

About 2.3 million Americans have been diagnosed with epilepsy, according to the Epilepsy Foundation of America in Landover, Md. Epilepsy refers to a whole group of nervous system disorders that cause repeated seizures. These seizures can take many forms, ranging from subtle, uncontrollable twitching to convulsive movements and loss of consciousness. Epilepsy has many possible causes, such as brain injuries and tumors.

The standard treatment for epilepsy is antiseizure medication. The physician may try one medication after another to find the drug that works best for a specific patient and which has the lowest possible side effects.

However, some patients continue having seizures after trying all available medications. For these people, surgery is an option to consider. In 1990, a consensus conference of the National Institutes of Health estimated surgery may be appropriate for 10 to 20% of people with epilepsy.

"Because of new technological developments in recent years, surgery has become a more important option for people with epilepsy," says Peter Van Haverbeke, director of public relations for the Epilepsy Foundation in Landover, Md. "Many people we know have experienced significant benefit from surgery, after trying medications that failed." However, he points out that medication is definitely the first course of action.

"In selected patients surgery can be a very important option," says Solomon L. Moshe, MD. "The important thing is to identify the best candidates for surgery, because each patient is different." Moshe is professor of neurology, neuroscience and pediatrics, director of pediatric neurology, and director of clinical neurophysiology at the Albert Einstein College of Medicine in New York City.

Researchers reviewed information from medical studies conducted to date and found that surgery for epilepsy caused by minor abnormalities in a certain region of the brain is successful about 41% of the time. In other words, these patients were seizure-free two years after surgery. The success rates of surgery for other, better-studied forms of epilepsy are even higher.

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